Week 5

Question 1

how do you palpate the liver

Answer 1

put one hand behind the liver and go under the rib cage looking for tenderness or pain

Question 2

Acute hepatitis

Answer 2

can be cured, it takes a little over a year of treatment and if not treated can lead to acute liver failure

Question 3

how can you tell someone is immunized vs has an acute infection

Answer 3

for immunization/past infection when you do a blood draw you will see antibodies. If you have an active infection you will see antigens

Question 4

Acute liver failure everything you need to know

Answer 4

1. High risk for bleeding
2. Hepatoencephalopathy
   - check LOC
3. treat with Lactulose
4. can develop chronic hepatitis

Question 5

what are the precautions for chronic hepatitis

Answer 5

standard

Question 6

how do you know laculose is working

Answer 6

patient is poopping alot

Question 7

What are the main causes of cirrhosis

Answer 7

alcohol and hepatitis

Question 8

Everything about cirrhosis

Answer 8

1. Transplant is the only cure
2. First sign: fatigue then weight loss (r/t poor apetite b/c liver is responsible for making digestive enzymes
3. give a high calorie diet low in protein and high in carbs (carbs are easy to digest and protein ->NH3 buildup)

Question 9

what is different about diet for patients with cirrhosis r/t alcoholism vs hepatitis

Answer 9

There diets need to be high in protein b/c theyre very malnurished and dehydrated

Question 10

3 signs of cirrhosis (late)

Answer 10

1. concentrated urine (amber color) and clay colored stools b/c of billirubin
2. pruritis
3. Jaundice

Question 11

liver assessment cultural considerations

Answer 11

African americans and asians NORMALLY have yellow scleras therefore checking mucous membranes would be ideal

Question 12

which hepatitis is the worst and why

Answer 12

Hep C b/c it has no symptoms but now there is a cure its called Harvoni

Question 13

Fibroscan vs Fibrosure

Answer 13

Scan-checking for cancer

shows degree of fibrosis

Question 14

Cirrhosis teaching

Answer 14

1. avoid acetaminophen (max 2-3Gs a day)

2. aspirin and other NSAIDS (risk for bleeding)

Question 15

what happens if you as a healthcare worker stick yourself and the patient has cirrhosis

Answer 15

you need immunoglobulin ASAP

Question 16

Pancreatitis first sign then rest of signs

Answer 16

All signs are caused by systemic inflammation
First you get indigestion
then swelling which leads to the release of more inflammatory mediators (interleukins, prostaglandins, histamines) causing vasodilation and increasing membrane permeability -> 3rd spacing (edema) and also can cause bronchospasm (mainly histamine)

Question 17

Acute pancreatitis Etiology

Answer 17

1. gallbladder disease (RUQ pain)
   - 1 in 4 women get gallbladder disease
2. chronic alcohol intake
3. smoking, coffee
4. Hypertriglyceridemia

Question 18

Physical assessment of acute pancreatitis

Answer 18

Piercing/sharp midline epigastric pain that radiates to the back

Question 19

Acute pancreatitis safety consideration

Answer 19

do not give pain medication until you figure out what kind of pancreatitis it is (obstructive vs non obstructive). If they have obstructive and you give them pain medication it will mask the pain and their pancreas will rupture without anyone knowing.

Question 20

CMs of acute pancreatitis

Answer 20

1. abdominal discoloration
2. Grey turners sign- blue discoloration of flanks
3. Cullens sign - blue around periumbilical area

Question 21

Complication of acute pancreatitis

Answer 21

Psuedocyst
-a sac filled with fluids, enzymes and other things
Pancreatic abscess
-Collection of pus (usually need surgery unlike cyst)

Question 22

what is the gold standard diagnostic test for any GI problem

Answer 22

CT scan

Question 23

Expected labs for acute pancreatitis

Answer 23

everything is up including liver enzymes and bilirubin BUT calcium decreases

Question 24

what is the treatment for acute pancreatitis and what are some of the considerations

Answer 24

1. Acute pancreatitis usually heals itself and all you need to do is manage symptoms and insulin. Therefore morphine is the drug of choice but it does mimic the s/s of acute pancreatitis b/c it causes spasm of the sphinctor of oddi (in the pancrease)
2. manage the B.S
3. Relax the pancreas by putting them NPO
4. NG tube decompression

Question 25

TPN considerations

Answer 25

1. run electrolytes prior to making the bag 2. Must be given through a central line - PPN can be given through IV 3. Has high glucose - Q4H accu checks 4. if Potassium is to high start them on D10W (a form of PPN) 5. two RNs must sign for TPN to be given 6. when removing you have to assess the length of the tubing because the tip may have fallen out and is now chillen in the blood stream

Question 26

Why are PPIs given in acute pancreatitis

Answer 26

they reduce acid which relaxes the pancreases because acid stimulates the pancrease

Question 27

what are the Colloid type solutions

Answer 27

Albumin and Dextran | they both have high molecular weight therefore they are hypertonic, drawing fluid into the vascular space

Question 28

why are lactated ringers awesome for burn patients

Answer 28

theyre an isotonic solution that have a less tendancy to cause 3rd spacing but still have alot of electrolytes.

Question 29

when do you give hypotonic fluids

Answer 29

when electrolytes like Na and K+ are high

Question 30

what happens to the brain when you have hyponatremia

Answer 30

it swells

Question 31

Hypomagnesia complications

Answer 31

1. torsades | 2. seizures

Question 32

Diet for acute pancreatitis

Answer 32

1. first NPO | 2. Start with carbs only b/c easy to digest

Question 33

what is the most comfortable position for aacute pancreatitis

Answer 33

1. fetal poisition (legs flexed) | 2. side lying w/ bed elevated to 45

Question 34

what are carbonic anhydrase inhibitors used for

Answer 34

decrease pancreatic secretions

Question 35

Chronic pancreatitis interventions

Answer 35

1. No need for NPO but give high carb meals in small sizes | 2. Treat Steatorrhea with bile salts to increase the absorption of DEAK and help with fat digestion

Question 36

chronic pancreatitis teaching

Answer 36

1. diet 2. Antacids AC and HC 3. digestive enzymes AC

Question 37

Cirrhosis complications

Answer 37

1. bleeding - the liver is stiff therefore venous pressure goes up causing the formation of varices which can bleed. This is why we give bblockers and endoscopic banding which is where you cauterize bleeding varices 2. Ascities - Paracentesis to treat (up to 5L at a time but you gotta go slow b/c fluid shift can cause severe hypotension) - will cause low albumin therefore take daily weights - Measure abdomin at the highest point 3. Hepatoencephalopathy 4. Hepatorenal syndrome- high portal pressure causes spasm of renal arteries leading to renal ischemia 8i

Question 38

Transjugular intrahepatic portosystemic shunt (TIPS)

Answer 38

shunts blood away from the liver to decrease chance of bleeding

Question 39

Sengstaken Blakemore tube

Answer 39

Used to stop bleeding by using a balloon to cause a mechanical obstruction/pressure directly on the site of bleeding

Question 40

Cirrhosis considerations

Answer 40

1. ROM b/c these patients are bed ridden. | 2. Elevate scrotum b/c it fills with fluids and can rupture.

Question 41

what type of pain will a pt with cholecystitis feel

Answer 41

RUQ pain radiating to right shoulder

Question 42

how can you stimulate micturition in clients with spastic bladder

Answer 42

1. stroking the inner thigh 2. diuretics do not work you need antispasmodics 3. NOT crede maneuver which only works for flaccid bladders (direct pressure applied over the bladder to express urine) 4. NOT valsalva which only works for flaccid bladder

Question 43

Autonomic dysreflexia

Answer 43

A syndrome where you have a sudden increase in BP you should 1. elevate HOB (priority) 2. loosen clients clothing (body temp and tactile stimulation stimulate the reflex) 3. Empty bladder and have a bowel movement (full bladder and fecal impaction triggers the reflex) 4. Hydralazine